Provider Demographics
NPI:1932128212
Name:SUESBERRY, WILBUR (MD)
Entity Type:Individual
Prefix:
First Name:WILBUR
Middle Name:
Last Name:SUESBERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 GARCES HWY
Mailing Address - Street 2:207
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-3639
Mailing Address - Country:US
Mailing Address - Phone:661-721-1422
Mailing Address - Fax:661-721-2738
Practice Address - Street 1:1205 GARCES HWY
Practice Address - Street 2:207
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3639
Practice Address - Country:US
Practice Address - Phone:661-721-1422
Practice Address - Fax:661-721-2738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29033174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C290330Medicaid
CA00C290330Medicare ID - Type Unspecified
CAA33816Medicare UPIN